Posts filed under ‘Judith Stein’

Priorities: People – and Medicare – Before Drug Company Profits

As we said in today’s Politico Op Ed, it’s time to support Senator Rockefeller’s bill – and all serious efforts to reduce what Medicare pays for prescription drugs. High time. There are over 50 million people with Medicare. Why would we not insist on lowering drug prices for all of them? It would save Medicare $141 Billion over ten years. Wal-Mart knows the value of negotiating low prices for vast numbers of people, and is sure to do so. So should Medicare.

April 17, 2013 at 2:35 pm Leave a comment

ACA is Good for Medicare!

Misconceptions and misinformation about the Affordable Care Act are still too many to innumerate. However, as advocates for Medicare beneficiaries and a strong Medicare program, we can tell you that the Affordable Care Act (ACA) is good for beneficiaries and good for the stability of a full and fair Medicare program. ACA has already added significantly to Medicare-covered preventive services – with no beneficiary cost-sharing, continues to reduce the cost of prescription drugs for people under Medicare Part D, is phasing out wasteful overpayments to private Medicare Advantage plans and added over a decade to Medicare’s long-term solvency.

Happy Anniversary, ACA. As my grandmother would say, “You should live and be well!”

March 25, 2013 at 5:23 pm Leave a comment

Ryan Retread: Ideology Trumps Medicare Protection and Deficit Reduction

The Ryan plan for 2013 is the same as the Ryan plan for 2012 and 2011: Privatize Medicare and repeal the Affordable Care Act. Once again the Ryan budget proposes to preserve Medicare in name only. It would change Medicare into a defined voucher system, sending beneficiaries into the marketplace to purchase indiivual insurance plans. These ideas were at the heart of the 2012 election. They are about changing the way government and Medicare work, not about saving Medicare or money. The proposals were rejected at the polls.

If Medicare and the deficit are really our concern, there are real savings possible that would not harm older and disabled people: Bring down the prices Medicare pays for drugs. Stop all overpayments to private Medicare Advantage plans. Add a prescription drug benefit to traditional Medicare. Lower the age of eligibility for Medicare. Let the Affordable Care Act work.

Mr. Ryan, move on! Join us in focusing on real solutions.

March 13, 2013 at 2:02 pm 1 comment

Judge Approves Settlement in Jimmo vs. Sebelius After Court Hearing

The Center for Medicare Advocacy, along with its co-counsel Vermont Legal Aid are pleased that the Settlement Agreement in the Medicare Improvement Standard case, Jimmo v. Sebelius, was approved January 24, 2013 at the conclusion of a scheduled fairness hearing, marking a critical step forward for thousands of beneficiaries nationwide.

The plaintiffs joined with the named defendant, Secretary of Health and Human Services Kathleen Sebelius, in asking the federal judge to approve the settlement of the case. With only one written comment received, and no class members appearing at the fairness hearing to question the settlement, Chief Judge Christina Reiss granted the motion to approve the Settlement Agreement on the record, while retaining jurisdiction to enforce the agreement in the future, as requested by the parties.

“We are not surprised but are very pleased that the judge ruled the settlement is fair, reasonable and adequate,” said Gill Deford, Litigation Director of the Center for Medicare Advocacy. “This moment is a culmination of two years of hard work, in conjunction with partners and advocates, to ensure that those who need health services covered under the Medicare law are not denied based on an illegal, outdated rule of thumb.”

With the settlement now officially approved, the Centers for Medicare & Medicaid Services (CMS) is tasked with revising its Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatients settings.  CMS must also develop and implement a nationwide education campaign for all who make Medicare determinations to ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their underlying conditions will not improve.

“It is important to note that the Settlement Agreement standards for Medicare coverage of skilled maintenance services apply now – while CMS works on policy revisions and its education campaign,” said Judith Stein, Executive Director, Center for Medicare Advocacy. “We’ve been hearing from beneficiaries who are still being denied Medicare coverage based on an Improvement Standard. Coverage should be available now for people who need skilled maintenance care and meet any other qualifying Medicare criteria. This is the law of the land – agreed to by the federal government and approved by the federal judge. We encourage people to appeal should they be denied Medicare for skilled maintenance nursing or therapy because they are not improving.”

For people needing assistance with appeals, the Center for Medicare Advocacy has self-help materials available on its website, www.medicareadvocacy.org.  This information can help individuals understand proper coverage rules and learn how to contest Medicare denials for outpatient, home health, or skilled nursing facility care.

“It is exciting to know that by this time next year, Medicare policies will clearly state that coverage for skilled maintenance nursing and therapy is available, and that a beneficiary’s access to coverage does not depend on the potential for improvement, but rather on the need for skilled care,” continued Stein.

To speak with a representative of the Center for Medicare Advocacy, please contact Lauren Weybrew at lweybrew@douglasgould.com or 914-833-7093. Learn more about the Center for Medicare Advocacy at www.medicareadvocacy.org

January 24, 2013 at 9:55 pm 2 comments

Medicare Helps People With Chronic Conditions Stay Home

Few people understand the value of Medicare’s home health coverage. In fact, many people who qualify for Medicare instead pay out-of-pocket, go without needed care, look to Medicaid for payment, or even enter nursing homes unnecessarily. Learn about Medicare home health coverage from nationally known beneficiary advocates. This Wednesday, September 12th!

Medicare Home Health Coverage for People With Long-term and Chronic Conditions
Presented by: Judith Stein, Executive Director/Attorney and Margaret Murphy, Associate Director/Attorney

September 12 from 2:00 – 3:00 PM EDT

Unknown to most people with Medicare, and contrary to what is often stated by the Centers for Medicare & Medicaid Services (CMS), the Medicare home health benefit can provide long term coverage for those who qualify. This webinar will help advocates understand the potential of this important coverage so that people with long-term and chronic conditions can obtain the nursing, therapy and home health aide care they need to remain at home. The presenters will explain:

* Prerequisites to obtaining Medicare home health coverage;
* Real and imagined limitations to coverage;
* Advocacy tips for obtaining and maintaining coverage;
* How to appeal home health coverage denials.

Register at http://www.naela.org/store/SearchResults.aspx?EventType=WEB

Download Speaker Bios at http://www.naela.org/app_themes/public/PDF/Meeting%20PDFs/Webinar/2012sep12webinarbio.pdf

September 10, 2012 at 7:54 pm Leave a comment

Fight for Medicare

The so-called Medicare wars are really a unilateral assault to the community Medicare program by those who favor privatization. Private plans are well known to cost more within and outside of Medicare. For decades, various experiments with private Medicare plans have proved more expensive than traditional Medicare. Nothing in Mr. Ryan’s plan is new or any more likely to save Medicare money. In fact, his plan would reintroduce vast overpayments to private Medicare plans that were rolled back by the Affordable Care Act. If the goal is to save Medicare, provide fair access to health care for its beneficiaries, and reduce spending – defeat efforts to turn Medicare into a private voucher system.

August 21, 2012 at 4:45 pm Leave a comment

We All Lose – If The Supreme Court Strikes Down Health Reform

Millions of people will be left with limited or no access to health care if the Affordable Care Act (ACA) is overturned. This will include people of all ages − older and disabled people with Medicare, middle class families, children with asthma and other pre-existing conditions, and adults with on-going medical needs. At this time, when family incomes are stretched to the max, many people are unemployed, and fewer jobs provide health insurance, individuals and families all over the country will lose if the Court strikes down Health Care Reform.

Older and disabled people with Medicare will lose access to preventive health care, help paying for life-saving medications, and an annual health visit. Taxpayers will resume overpayments to private Medicare plans. Children with preexisting conditions will again be subject to discrimination by private health insurance companies. People who would have gained access to coverage under ACA, beginning in 2014, will lose out. This includes adults with pre-existing conditions, those with high out-of-pocket costs, and families with moderate incomes. Young adults who, thanks to ACA, have health coverage under their parents’ plans will also be in jeopardy.

In short, if the Court strikes down the law we all lose. The number of people with inadequate or no health insurance will rise – but those same people will still get sick and injured, and require care. And we will all pay, in emergency rooms, unpaid hospital bills, higher premiums – or simply by catching their illnesses.

Let’s hope the Supreme Court recognizes the national interest in making basic health insurance available to all. If it does, we will all feel better.

June 27, 2012 at 7:39 pm Leave a comment

Tell the Truth!

This week, Republican presidential candidates vie for their party’s nomination in Florida, where millions of residents rely on Medicare as a health and economic lifeline for themselves and their families. Unfortunately, some candidates are scaring seniors – making clearly incorrect and harmful statements about the effect of the Affordable Care Act on Medicare.
(See: http://www.washingtonpost.com/national/health-science/santorum-warns-florida-seniors-that-obama-health-care-law-will-force-doctors-to-leave-medicare/2012/01/23/gIQAzX4VLQ_story.html.)

As the Center for Medicare Advocacy has reported since the passage of the landmark legislation, Health Care Reform does NOT hurt Medicare benefits. In fact, it expands and improves benefits for all people with Medicare while saving our nation and taxpayers billions of dollars over the next decade.

Most recently, former Senator Santorum made significant misstatements about Medicare. Contrary to his statements, people with Medicare are NOT losing their doctors and are NOT facing rationing because of Health Care Reform. In fact, the Medicare payment board he mentions does not even exist yet. When it does begin, it will be charged with keeping overall Medicare costs down and will be specifically prohibited from reducing benefits.

Additionally, Mr. Santorum’s desire to “fix” Medicare by privatizing it and giving taxpayer money to insurance companies makes you wonder who he really wants to help. Privatizing Medicare and repealing health reform, which he also recommends, won’t help Florida’s older people or their families, but it would provide a windfall to the insurance industry. The traditional community Medicare program has helped generations of Americans at far less cost than private insurance. And health care reform has already enhanced Medicare, adding preventive benefits with no cost-sharing and reducing costs for prescription drugs.

If the Senator is truly concerned for the care of Florida’s people who rely on Medicare and the program’s integrity, he should get the facts straight and speak the truth about Medicare and health care reform. To start, he can visit the Center’s “Solutions for Strengthening Medicare” for common-sense ways to improve and expand the program while saving billions of dollars. www.medicareadvocacy.org.

January 23, 2012 at 10:04 pm Leave a comment

CMA in the New York Times: Don’t Privatize Medicare

http://www.nytimes.com/2011/12/10/opinion/medicare-and-private-health-insurance.html

December 18, 2011 at 3:37 am Leave a comment

Federal Judge Refuses To Dismiss Medicare Beneficiaries’ Challenge To The Medicare “Improvement Standard”

Plaintiffs have overcome a major hurdle in a lawsuit filed by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of Medicare beneficiaries with long-term and chronic conditions. In a comprehensive 35-page decision, Chief Judge Christina Reiss refused the federal government’s request to throw out a lawsuit that seeks to end use of an illegal Improvement Standard to deny Medicare coverage. The Improvement Standard is a “rule of thumb” that Medicare uses to deny or terminate coverage to beneficiaries whose conditions are not improving. Jimmo v. Sebelius, Civil No. 5:11-CV-17 (D. VT. 10/25/20011).

“The Improvement Standard is the most unfair and harmful reason for Medicare denials,” stated Judith Stein, executive director of the Center for Medicare Advocacy. “It has a particularly devastating effect on patients with chronic conditions such as Multiple Sclerosis, Alzheimer’s disease, ALS, Parkinson’s disease, and paralysis.”

The lawsuit, which was filed in January of this year, was brought on behalf of a nationwide class of Medicare beneficiaries by six individual beneficiaries and seven national organizations representing people with chronic conditions.

In asking the court to dismiss the case, the government raised several arguments to contend that the court lacked jurisdiction over the plaintiffs’ claims. The government also argued that the plaintiffs failed to state a claim, namely, that there was no proof that the government was even applying such a policy as the Improvement Standard. Judge Reiss rejected that contention. She did agree, however, that the court lacked jurisdiction over one beneficiary plaintiff and one organizational plaintiff, but the case will go forward with the remaining eleven plaintiffs.

“Judge Reiss understands the core issue plaintiffs in this case seek to address,” stated Michael Benvenuto, attorney for plaintiffs from Vermont Legal Aid. “They are not seeking individual claim reviews; they are challenging a broad secret policy.”

“This is a great first step for these plaintiffs and for Medicare beneficiaries in general,” remarked Gill Deford, the lead attorney for the plaintiffs. “The Improvement Standard has been used for over 30 years to deprive hundreds of thousands of Medicare beneficiaries of coverage they desperately needed. This decision starts the process of ending that illegal policy.”

October 26, 2011 at 9:05 pm Leave a comment

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We provide effective, innovative opportunities to impact federal Medicare and health care policies and legislation in order to advance fair access to Medicare and quality health care.

Judith A. Stein, Executive Director

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